Health benefits of tai chi: What is the evidence?

Abstract

Objective To summarize the evidence on the health benefits of tai chi.

Sources of information A literature review was conducted on the benefits of tai chi for 25 specific conditions, as well as for general health and fitness, to update a 2014 review of systematic reviews. Systematic reviews and recent clinical trials were assessed and organized into 5 different groups: evidence of benefit as excellent, good, fair, or preliminary, or evidence of no direct benefit.

Main message During the past 45 years more than 500 trials and 120 systematic reviews have been published on the health benefits of tai chi. Systematic reviews of tai chi for specific conditions indicate excellent evidence of benefit for preventing falls, osteoarthritis, Parkinson disease, rehabilitation for chronic obstructive pulmonary disease, and improving cognitive capacity in older adults. There is good evidence of benefit for depression, cardiac and stroke rehabilitation, and dementia. There is fair evidence of benefit for improving quality of life for cancer patients, fibromyalgia, hypertension, and osteoporosis. Current evidence indicates no direct benefit for diabetes, rheumatoid arthritis, or chronic heart failure. Systematic reviews of general health and fitness benefits show excellent evidence of benefit for improving balance and aerobic capacity in those with poor fitness. There is good evidence for increased strength in the lower limbs. There is fair evidence for increased well-being and improved sleep. There were no studies that found tai chi worsened a condition. A recent systematic review on the safety of tai chi found adverse events were typically minor and primarily musculoskeletal; no intervention-related serious adverse events have been reported.

Conclusion There is abundant evidence on the health and fitness effects of tai chi. Based on this, physicians can now offer evidence-based recommendations to their patients, noting that tai chi is still an area of active research, and patients should continue to receive medical follow-up for any clinical conditions.

T ai chi is a meditative martial art that has been practised in China for centuries and that has become increasingly popular in the West.

It consists of a series of gentle movements that strengthen and relax the body and mind.

There are different schools of tai chi, yet all share key features such as mindfulness, structural alignment, and flexibility (Table 1).

New forms of tai chi continue to evolve, including shortened protocols for the elderly. Some forms, such as Taoist tai chi, have a specific health recovery focus.

With tai chi becoming increasingly popular, patients might ask physicians whether it could be beneficial for them. The objective of this review was to summarize the evidence on the therapeutic benefits of tai chi so that clinicians can offer evidence-based rec- ommendations to their patients.

Case description

B.G., a 48-year-old woman, comes into your office for follow-up of borderline hypertension and a slightly elevated fasting blood glucose level. She has worked all her adult life and recently

Health benefits of tai chi

What is the evidence?

Patricia Huston

Bruce McFarlane

Editor’s KEy Points

 • Tai chi is a meditative martial art that consists  of a series of gentle movements designed  to strengthen and relax the body and mind. 

Increasingly, its therapeutic effects have come  under study. This review aims to summarize the  evidence on the therapeutic and fitness benefits  of tai chi so that clinicians can offer evidence- based recommendations to their patients.

 • More than 500 studies and 120 systematic  reviews have been published. The strongest  evidence of benefit is for preventing falls  in older adults living in the community,  osteoarthritis, Parkinson disease, chronic  obstructive pulmonary disease rehabilitation,  improving cognitive capacity, and improving  balance and aerobic capacity.

  This article is eligible for Mainpro+  

  certified Self-Learning credits. To earn  credits, go to www.cfp.ca and click on the  Mainpro+ link.

This article has been peer reviewed.

Can Fam Physician 2016;62:881-90

La traduction en français de cet article se trouve 

à www.cfp.ca dans la table des matières du 

numéro de novembre 2016 à la page e645.

the last of her 3 grown children has left home. When you ask how things are going, she says she is OK but feels burned out. She has neglected herself, gets no regular exercise, has gained some weight, and feels depressed about her “empty nest syndrome.” She asks about tai chi, noting that her mother swears by it. Her mother says she sleeps better, that her osteoar- thritis has improved, and that she is now more social- ly active than ever. On examination, B.G.’s blood

pressure is 140/85 mm Hg, her body mass index is 29 kg/m

, and screening reveals a positive score for depression. What should you do? What are your rec- ommendations regarding tai chi?

Sources of information

We reviewed the 2014 Evidence Map of Tai Chi, which is a “systematic review of systematic reviews” conducted by the Evidence-based Synthesis Program Centre for the US Department of Veterans Affairs.

We then conducted a MEDLINE review of systematic reviews and randomized controlled trials (RCTs) published after the evidence map up to October 2015. We assessed the evidence for spe- cific conditions, as well as evidence for general health and fitness benefits, and then classified it into 1 of 5 catego- ries: evidence of benefit was excellent if there were many systematic reviews noting consistent evidence of benefit, good if there were several systematic reviews that gen- erally showed benefit, fair if there were a few systematic reviews that overall showed benefit but that might have included mixed results, and preliminary if there were only a few trials or 1 or 2 systematic reviews; evidence of no direct benefit was based on systematic reviews that showed no direct benefit for the condition under study (even if a gen- eral health benefit might have been documented).

Main message

Research on tai chi has exploded in the past 45 years.

A bibliometric analysis of clinical studies published between 1958 and 2013 found more than 500 studies on tai chi from 21 countries,

mostly supported by govern- ment funding. The number of articles published on tai chi in PubMed journals has been increasing exponen- tially (Figure 1). In 2015 there were, on average, 15 arti- cles published each month.

Evidence was reviewed for general health and fitness and 25 different conditions and then organized

0 50 100 150 200

2015

2013

2011

2009

2007

2005

2003

2001

1999

1997

1995

1993

1991

1989

1986

1983

1981

1977

1974

Citations Figure 1. PubMed tai chi article citations by year: January 1974 to October 2015.

table 1. Key features of tai chi

FEATURE DESCRIPTION

Mindfulness Awareness of the current moment is  cultivated during tai chi by focusing on the  body’s position, movements, and sensations Imagery Images are used as a learning strategy (eg,  one of the moves is called wave hands like clouds)

Structural 

alignment Movements are biomechanically efficient,  calling for the least amount of effort Flexibility and 

relaxation

Circular and flowing motions provide dynamic  stretching and help to shift the body and  mind into a state of deeper relaxation Strength and 

balance Placing weight on one foot at a time in a  slightly flexed position leads to greater  strength in the lower extremities and  improved balance

Natural  breathing

Rhythmic breathing with movement appears  to improve gas exchange and promote  calmness

Social support Positive interactions within a community give  a sense of belonging and support

Integration of  body, mind,  and spirit

Tai chi creates a practical framework for  living a more holistic life

Adapted from Wayne.

according to the quality of evidence for benefit: excellent, good, fair, preliminary, or evidence of no direct benefit.

Excellent evidence of benefit. There are 5 conditions that had many systematic reviews showing consistent evidence of benefit for tai chi: preventing falls in older adults in the community, osteoarthritis, Parkinson dis- ease, chronic obstructive pulmonary disease (COPD), and cognitive functioning.

Fall prevention in the community: There were 14 systematic reviews summarizing trials on fall preven- tion in older adults living in the community.

Some looked at multiple interventions including tai chi,

and others looked specifically at tai chi.

Reviews consistently found a decreased risk of falls in the tai chi groups, typically associated with improvements in static and dynamic balance. One review identified tai chi as the most cost-effective intervention to pre- vent falls.

In addition, 4 systematic reviews identi- fied that tai chi decreased the fear of falling.

Tai chi was not found to be as beneficial for those need- ing assisted living, such as visually impaired adults in residential care.

This is consistent with a Cochrane review that found most interventions, including all exercise programs, were not effective in preventing falls in frail, institutionalized elderly patients,

and with a recent trial that did not show benefit in preclini- cally disabled adults.

Osteoarthritis: There were 10 systematic reviews on osteoarthritis and all found that exercise, including tai chi, was associated with improvements, especially for osteoarthritis of the knee.

One meta-analysis of tri- als on tai chi for osteoarthritis found statistically signifi- cant improvements in pain (P = .0005), stiffness (P = .04), and physical function (P < .00001).

Recent trials have confirmed these findings

and another trial is under way.

Tai chi is now a conditional recommendation of the American College of Rheumatology for osteoarthritis of the hand, hip, and knee.

Parkinson disease: There were 8 systematic reviews on tai chi and Parkinson disease.

The key finding was that people with Parkinson disease who took medi- cation and did tai chi had better mobility and balance outcomes compared with those who took medica- tion alone. Since a study published in the New England Journal of Medicine,

there has been an increase in clini- cal trials,

including a study showing tai chi to be cost-effective.

An RCT is under way.

Chronic obstructive pulmonary disease: There were 6 systematic reviews on tai chi for asthma and COPD that found improvements in 6-minute walk test results, dyspnea, and forced expiratory volume in 1 second.

More definitive trials are now under way.

Cognitive functioning: Five systematic reviews found that tai chi improved cognitive performance.

A

meta-analysis found improved attention (P < .001) and processing speed (P < .001) in the tai chi group compared with controls.

There was a moderate effect size even compared with active controls.

These findings were confirmed in recent randomized trials.

Good evidence of benefit. There are 4 conditions that had several systematic reviews that generally showed benefit: depression, cardiac rehabilitation, stroke reha- bilitation, and dementia.

Depression: There were 8 systematic reviews on tai chi and depression.

Although many trials had small numbers and most were short term, the findings were consistently positive. More recently, a longer trial of 24 weeks with more than 200 participants with obesity and depression showed that the tai chi group had reduced severity of depression (P < .001).

Cardiac and stroke rehabilitation: There were 6 sys- tematic reviews on tai chi for cardiac rehabilitation.

Although the initial trials were small, there was a con- sistent finding of benefit. Tai chi might be particularly helpful for women with coronary artery disease

and the elderly.

Recent trials found increased functional capacity after myocardial infarction

and that tai chi was an effective alternative for those who could not attend formal rehabilitation.

There were 5 systematic reviews on tai chi for stroke rehabilitation

; all had positive findings but trial sizes were small. Studies that have been done since the last systematic review have found a consistent benefit

and additional trials are planned.

Cognitive impairment and dementia: There were 2 systematic reviews on tai chi for the treatment of cog- nitive impairment and dementia that showed improve- ments in Mini-Mental State Examination scores.

The Cochrane review of exercise programs for people with dementia concluded that tai chi was better than physical activity for improving executive function.

This is consistent with the evidence for improving cog- nitive capacity in older adults.

However, achiev- ing this benefit might take time; one recent short-term study of tai chi in those with mild cognitive impairment did not find an improvement.

Fair evidence of benefit. There are 4 conditions that had a few systematic reviews indicating that overall tai chi was effective, but some of the included trials did not show benefit: quality of life for cancer patients, fibromy- algia, hypertension, and osteoporosis.

Quality of life for cancer patients: There were 7 sys-

tematic reviews on quality of life for cancer patients,

most of which were among those with breast can-

cer.

Although results were mixed, in part owing

to different outcomes measures, overall there was a

positive pooled effect for vitality and mental health

similar to that found with regular exercise. A recent trial showed improved health-related quality of life and bio- markers in breast cancer survivors who did tai chi.

Fibromyalgia: There were 4 systematic reviews on fibromyalgia.

There were different outcomes measured and different trial lengths; some trials did not show benefit. A New England Journal of Medicine study showed a positive effect, but the sample size was small.

Overall the reviews indicated that people with fibromyal- gia who did tai chi reported less pain and had improved function. These benefits were confirmed in recent clini- cal trials.

Trial length might explain some of the ini- tial variability. A 6-month trial showed that a decrease in chronic pain appeared only after 4 to 6 months.

A 1-year head-to-head trial of aerobic exercise versus tai chi for fibromyalgia is under way.

In the meantime, some European countries have started to include tai chi in their fibromyalgia treatment guidelines.

Hypertension: There were 4 systematic reviews on hypertension that found tai chi lowered both sys- tolic and diastolic blood pressure; however, this find- ing was based on trials that had some methodologic weaknesses, and trial sizes were generally small.

A recent larger trial published in the American Journal of Cardiology found that tai chi reduced blood pressure and body mass index in the elderly.

Osteoporosis: There were 3 systematic reviews on osteoporosis.

One review reported reduced rates of decline in bone mineral density (BMD) in postmeno- pausal women compared with sedentary controls in most included trials, but evidence was limited.

Another review reported mixed results.

The third review did not report on BMD but found that tai chi did improve balance and so might prevent falls.

A recent trial found that the combination of tai chi and resistance training had the best outcome.

Again, the length of intervention might be important. A 9-month trial found that those who completed at least 75% of the classes in the tai chi group showed a statistically significant increase in BMD of the femoral head compared with the usual-care group.

Preliminary evidence of benefit. One systematic review on the primary prevention of stroke included 36 studies with more than 2300 participants and found a significant decrease in nonfatal stroke in the group that did tai chi (P = .03).

A Cochrane review of tai chi for primary prevention of cardiac disease concluded that the results were inconclusive, noting longer-term trials were needed.

Two systematic reviews showed that tai chi might be helpful for anxiety.

One sys- tematic review

and 3 recent trials

suggest tai chi has a beneficial effect on low back pain. One system- atic review showed tai chi helped breast cancer patients after surgery, as it consistently improved the mobility of

the affected arm.

Three trials on tai chi and multiple sclerosis found promising results, especially for improv- ing balance,

and another trial showed improved quality of life.

Preliminary trials have shown a ben- efit for schizophrenia

and posttraumatic stress dis- order.

Two trials indicated promising results for attention deficit disorder,

and a systematic review is planned.

Single studies have shown that tai chi was helpful for those with spinal cord injury,

for those with traumatic brain injury,

and for postsurgical nasopha- ryngeal cancer patients to increase neck mobility.

Evidence of no direct benefit. There were 3 conditions for which the evidence suggested tai chi might not have a direct benefit: type 2 diabetes, rheumatoid arthritis, and chronic heart failure.

There were 4 systematic reviews on tai chi and dia- betes

showing no effect on hemoglobin A

. A recent trial found no change in fasting glucose lev- els,

but another showed tai chi did improve quality of life.

Three systematic reviews on tai chi for rheuma- toid arthritis showed no improvement in joint tender- ness, pain, or swelling but did find improved range of motion,

and a recent study found improved qual- ity of life.

Two systematic reviews on tai chi for heart failure showed no change in N-terminal pro-brain natri- uretic peptide

but found improved performance out- comes,

and another showed improved quality of life.

Tai chi for general health and fitness. Tai chi has a number of general health and fitness benefits. There is excellent evidence that tai chi consistently improves balance, demonstrated by 10 systematic reviews

and 3 recent trials.

There is excellent evidence from 5 systematic reviews

and 2 recent tri- als

that tai chi improves aerobic capacity, espe- cially in those who have been sedentary. There is good evidence that tai chi can improve strength, especially in the lower limbs of adults who have been decondi- tioned,

and there is preliminary evidence that tai chi might improve flexibility.

In terms of general health, there is fair evidence that tai chi increases overall well-being

and improves sleep.

Improvements in sleep seem to be associated with reduced cellular inflammatory markers such as C-reactive protein and proinflam- matory cytokines.

There is 1 systematic review that suggests that tai chi might strengthen immune capacity

and very preliminary evidence that it might improve kidney function

and quality of life for hemodialysis patients.

The benefits of tai chi according to the different lev-

els of evidence for specific conditions and general health

and fitness are summarized in Table 2.

Excellent safety profile. There was 1 systematic review of 153 trials assessing the safety of tai chi

; only 50 included adverse event reporting. The most common adverse events were minor and primarily musculoskeletal, such as mild knee and back pain (presumably from misalign- ment); no intervention-related serious adverse events were reported.

disCUssion

There are more than 500 studies and 120 systematic reviews to assess the benefits of tai chi for 25 differ- ent conditions as well as for general health and fitness.

The results have varied from excellent, good, fair, and preliminary evidence of benefit to evidence of no direct benefit. The strongest evidence of benefit is for prevent- ing falls in older adults in the community, osteoarthritis, Parkinson disease, COPD rehabilitation, and improving cognitive capacity. The strength of this body of research is that it includes many systematic reviews and meta- analyses and, increasingly, high-quality RCTs. One of the strengths of our research is that we were consis- tently conservative in our assessments of the quality of evidence. For example, although more than 36 studies

have been done on tai chi for the primary prevention of stroke, and a meta-analysis found a statistically signifi- cant effect on nonfatal stroke, we still categorized this as preliminary evidence of benefit, as many of the tri- als were small and the overall effect was small. Tai chi appears to be excellent for balance and reestablishing aerobic capacity in those who have been deconditioned and for preventing or improving many of the common ailments associated with aging.

There are some limitations to this evidence, both from a research and a tai chi perspective. From a research perspective, many of the initial trials were small and had methodologic weakness. A key weakness was the lack of blinding of participants, but this was largely over- come by blinding those analyzing the results. Since tai chi has multiple features (Table 1),

it is difficult to know what aspect of tai chi has the greatest effect.

It is also not clear how tai chi works. For example, recent research has examined why tai chi seems to be so good for balance

and how it helps improve cognitive function.

Tai chi includes different styles, teachers, lengths, and frequencies. It is unclear whether one style might be better for some conditions than others, if lon- ger classes are better than shorter classes, or whether 2 or more classes a week is optimal. A final limitation

table 2. Tai chi research: Summary of evidence from 120 systematic reviews and recent clinical trials; there is very little evidence for italicized conditions.

ExCEllENT EvIDENCE

OF BENEFIT GOOD EvIDENCE OF BENEFIT FAIR EvIDENCE OF BENEFIT

wITH MIxED RESUlTS PRElIMINARy EvIDENCE

OF BENEFIT EvIDENCE OF

NO DIRECT BENEFIT

sPECiFiC Conditions Preventing falls

• 14 systematic  reviews Osteoarthritis

• 10 systematic  reviews Parkinson disease

• 8 systematic reviews COPD rehabilitation

• 6 systematic reviews Improving cognitive  capacity

• 5 systematic reviews

Depression

• 8 systematic reviews Cardiac rehabilitation

• 6 systematic reviews Stroke rehabilitation

• 5 systematic reviews Cognitive impairment  and dementia

• 2 systematic reviews

Quality of life for cancer  patients

• 7 systematic reviews Fibromyalgia

• 4 systematic reviews Hypertension

• 4 systematic reviews Osteoporosis

• 3 systematic reviews

Stroke prevention

• 1 systematic review Anxiety

• 2 systematic reviews Low back pain

• 1 systematic review Postoperative arm  mobility in breast cancer  patients

• 1 systematic review Multiple sclerosis

Schizophrenia

PTSD

Attention deficit disorder

After brain and spinal cord injury

Diabetes (eg, HbA

)

• 4 systematic reviews Rheumatoid arthritis

• 3 systematic reviews Chronic heart failure

• 2 systematic reviews

GEnErAL HEALtH And FitnEss BEnEFits Balance,

• 10 systematic  reviews

Aerobic capacity

• 5 systematic reviews

Strength

• 2 systematic reviews Well-being

• 4 systematic reviews Sleep

• 2 systematic reviews

Flexibility

• 1 systematic review Immune capacity

Kidney function

NA

COPD—chronic obstructive pulmonary disease, HbA

—hemoglobin A

, NA—not applicable, PTSD—posttraumatic stress disorder.

of tai chi research is that trial lengths of 6 to 12 weeks might not be sufficient to assess benefit, especially for chronic conditions. Fortunately, a number of long-term studies are now under way.

From a tai chi perspective, research on this art form to date might not have revealed all of its benefits. In our experience, many people who practise tai chi describe benefits that have not yet been studied—such as improved digestion, warmer hands and feet, and generally feeling younger. Although it is useful to know that benefits can be seen after only a few weeks, those who have practised tai chi for many years would note that benefits continue to accrue even after decades of practice.

A lot more research is under way, including longer, more rigorous clinical trials and assessment of the ben- efits for other conditions. And there is a lot of interest in understanding how tai chi works at a biochemical level. Early evidence suggests tai chi alters cytokines associated with pain perception,

enhances T cells,

and affects mononuclear cell functions in patients with cancer.

It would be interesting to assess the effect of tai chi on telomere length—an indicator of overall resil- ience and longevity.

Case resolution

You empathize with B.G.’s situation and reassure her that there are some things that can be done to improve her health and well-being. You suggest that now that her children have moved out, it is a good time to start something new. You agree that tai chi is a good choice—it is a gentle aerobic activity that also improves balance and strength. You note there is good evidence that tai chi could help her depres- sion and fair evidence that it might help improve her blood pressure. You discuss additional recom- mendations for her depression, hypertension, and blood sugar levels and arrange to see her again for follow-up.

Conclusion

Physicians can now provide evidence-based recommen- dations on tai chi to their patients, understanding that this is an active area of research. As with any exercise program, ongoing medical follow-up for any clinical condition is indicated.

Dr Huston is a family physician and a public health physician with the Department of Family Medicine and the School of Epidemiology, Public Health and Preventive Medicine at the University of Ottawa in Ontario. Dr McFarlane is a family physician recently working in the central Arctic.

Contributors

Both authors contributed to the literature review and interpretation, and to pre- paring the manuscript for submission.

Competing interests

Dr Huston has been practising tai chi for 3 years and assists in a Taoist Tai Chi health recovery class. Dr McFarlane has been learning from and teaching Taoist Tai Chi for 21 years and is a medical advisor to the Taoist Tai Chi Society of Canada.

Correspondence

Dr Patricia Huston; e-mail pg.huston@gmail.com

references

1. Hempel S, Taylor SL, Solloway MR, Miake-Lye IM, Beroes JM, Shanman R, et al. Evidence map of tai chi. Los Angeles, CA: Evidence-based Synthesis Program Center; 2014.

2. Wayne PM, Kaptchuk TJ. Challenges inherent to t’ai chi research: part I—t’ai chi as a complex multicomponent intervention. J Altern Complement Med 2008;14(1):95-102.

3. Wayne PM. The Harvard Medical School guide to tai chi: 12 weeks to a healthy body, strong heart, and sharp mind. Boston, MA: Shambhala Publications Inc; 2012.

4. International Taoist Tai Chi Society [website]. Tallahassee, FL: International Taoist Tai Chi Society; 2016. Available from: www.taoist.org. Accessed 2016 Jun 25.

5. Yang GY, Wang LQ, Ren J, Zhang Y, Li ML, Zhu YT, et al. Evidence base of clinical studies on tai chi: a bibliometric analysis. PLoS One 2015;10(3):e0120655.

6. Mat S, Tan MP, Kamaruzzaman SB, Ng CT. Physical therapies for improv- ing balance and reducing falls risk in osteoarthritis of the knee: a systematic review. Age Ageing 2015;44(1):16-24. Epub 2014 Aug 22.

7. El-Khoury F, Cassou B, Charles MA, Dargent-Molina P. The effect of fall pre- vention exercise programmes on fall induced injuries in community dwelling older adults: systematic review and meta-analysis of randomised controlled trials. BMJ 2013;347:f6234.

8. Winter H, Watt K, Peel NM. Fall prevention interventions for community- dwelling older persons with cognitive impairment: a systematic review. Int Psychogeriatr 2013;25(02):215-27. Epub 2012 Oct 3.

9. Gillespie LD, Robertson MC, Gillespie WJ, Sherrington C, Gates S, Clemson LM, et al. Interventions for preventing falls in older people living in the com- munity. Cochrane Database Syst Rev 2012;(9):CD007146.

10. Schleicher MM, Wedam L, Wu G. Review of tai chi as an effective exercise on falls prevention in elderly. Res Sports Med 2012;20(1):37-58.

11. Fairhall N, Sherrington C, Clemson L, Cameron ID. Do exercise interventions designed to prevent falls affect participation in life roles? A systematic review and meta-analysis. Age Ageing 2011;40(6):666-74. Epub 2011 Jul 14.

12. Church J, Goodall S, Norman R, Haas M. An economic evaluation of com- munity and residential aged care falls prevention strategies in NSW. N S W Public Health Bull 2011;22(4):60-8.

13. Michael Y, Lin J, Whitlock E. Interventions to prevent falls in older adults: an updated systematic review. Evidence Syntheses no. 80. Rockville, MD: Agency for Healthcare Research and Quality; 2010. Available from: www.ncbi.nlm.

nih.gov/books/NBK51685. Accessed 2016 Sep 23.

14. Sherrington C, Whitney JC, Lord SR, Herbert RD, Cumming RG, Close JC.

Effective exercise for the prevention of falls: a systematic review and meta‐

analysis. J Am Geriatr Soc 2008;56(12):2234-43.

15. Logghe IH, Verhagen AP, Rademaker AC, Bierma-Zeinstra SM, van Rossum E, Faber MJ, et al. The effects of tai chi on fall prevention, fear of falling and balance in older people: a meta-analysis. Prev Med 2010;51(3-4):222-7. Epub 2010 Jun 15.

16. Low S, Ang LW, Goh KS, Chew SK. A systematic review of the effective- ness of tai chi on fall reduction among the elderly. Arch Gerontol Geriatr 2009;48(3):325-31. Epub 2008 Apr 16.

17. Gregory H, Watson MC. The effectiveness of tai chi as a fall prevention intervention for older adults: a systematic review. Int J Health Promot Educ 2009;47(3):94-100.

18. Yıldırım P, Ofluoglu D, Aydogan S, Akyuz G. Tai chi vs. combined exercise prescription: a comparison of their effects on factors related to falls. J Back Musculoskelet Rehabil 2016;29(3):493-501.

19. Harling A, Simpson JP. A systematic review to determine the effectiveness of tai chi in reducing falls and fear of falling in older adults. Phys Ther Rev 2008;13(4):237-48.

20. Kendrick D, Kumar A, Carpenter H, Zijlstra G, Skelton DA, Cook JR, et al.

Exercise for reducing fear of falling in older people living in the community.

Cochrane Database Syst Rev 2014;(11):CD009848.

21. Zijlstra GA, van Haastregt JC, van Rossum E, van Eijk JT, Yardley L, Kempen GI. Interventions to reduce fear of falling in community‐living older people: a systematic review. J Am Geriatr Soc 2007;55(4):603-15.

22. Gleeson M, Sherrington C, Keay L. Exercise and physical training improve physical function in older adults with visual impairments but their effect on falls is unclear: a systematic review. J Physiother 2014;60(3):130-5. Epub 2014 Jul 25.

23. Cameron ID, Gillespie LD, Robertson MC, Murray GR, Hill KD, Cumming RG, et al. Interventions for preventing falls in older people in care facilities and hospitals. Cochrane Database Syst Rev 2012;(12):CD005465.

24. Day L, Hill KD, Stathakis VZ, Flicker L, Segal L, Cicuttini F, et al. Impact of tai-chi on falls among preclinically disabled older people. A randomized con- trolled trial. J Am Med Dir Assoc 2015;16(5):420-6. Epub 2015 Mar 10.

25. Ye J, Cai S, Zhong W, Cai S, Zheng Q. Effects of tai chi for patients with knee osteoarthritis: a systematic review. J Phys Ther Sci 2014;26(7):1133-7.

Epub 2014 Jul 30.

26. Shengelia R, Parker SJ, Ballin M, George T, Reid MC. Complementary thera- pies for osteoarthritis: are they effective? Pain Manag Nurs 2013;14(4):e274- 88. Epub 2012 Mar 21.

27. Uthman OA, van der Windt DA, Jordan JL, Dziedzic KS, Healey EL, Peat GM, et al. Exercise for lower limb osteoarthritis: systematic review incorporating trial sequential analysis and network meta-analysis. BMJ 2013;347:f5555.

28. Lauche R, Langhorst J, Dobos G, Cramer H. A systematic review and meta-analysis of tai chi for osteoarthritis of the knee. Complement Ther Med 2013;21(4):396-406. Epub 2013 Jul 1.

29. Yan J, Gu W, Sun J, Zhang W, Li B, Pan L. Efficacy of tai chi on pain, stiffness and function in patients with osteoarthritis: a meta-analysis. PLoS One 2013;8(4):e61672.

30. Macfarlane GJ, Paudyal P, Doherty M, Ernst E, Lewith G, MacPherson H, et al. A systematic review of evidence for the effectiveness of practitioner-based com- plementary and alternative therapies in the management of rheumatic diseases:

osteoarthritis. Rheumatology (Oxford) 2012;51(12):2224-33. Epub 2012 Aug 25.

31. Kang JW, Lee MS, Posadzki P, Ernst E. T’ai chi for the treatment of osteoar- thritis: a systematic review and meta-analysis. BMJ Open 2011;1(1):e000035.

32. Selfe TK, Innes KE. Mind-body therapies and osteoarthritis of the knee. Curr Rheumatol Rev 2009;5(4):204-11.

33. Escalante Y, Garcia-Hermoso A, Silva AJ, Barbosa TM. Physical exercise and reduction of pain in adults with lower limb osteoarthritis: a systematic review.

J Back Musculoskeletal Rehabil 2010;23(4):175-86.

34. Hall A, Maher C, Latimer J, Ferreira M. The effectiveness of tai chi for chronic musculoskeletal pain conditions: a systematic review and meta‐analysis.

Arthritis Care Res 2009;61(6):717-24.

35. Tsai P, Chang JY, Beck C, Kuo Y, Keefe FJ. A pilot cluster-randomized trial of a 20-week tai chi program in elders with cognitive impairment and osteo- arthritic knee: effects on pain and other health outcomes. J Pain Symptom Manage 2013;45(4):660-9. Epub 2012 Sep 24.

36. Callahan LF, Cleveland RJ, Altpeter M, Hackney B. Evaluation of tai chi pro- gram effectiveness for people with arthritis in the community: a randomized controlled trial. J Aging Phys Act 2016;24(1):101-10. Epub 2015 Jun 18.

37. Wang C, Iversen MD, McAlindon T, Harvey WF, Wong JB, Fielding RA, et al.

Assessing the comparative effectiveness of tai chi versus physical therapy for knee osteoarthritis: design and rationale for a randomized trial. BMC Complement Altern Med 2014;14(1):333.

38. Hochberg MC, Altman RD, April KT, Benkhalti M, Guyatt G, McGowan J, et al. American College of Rheumatology 2012 recommendations for the use of nonpharmacologic and pharmacologic therapies in osteoarthritis of the hand, hip, and knee. Arthritis Care Res 2012;64(4):465-74.

39. Zhou J, Yin T, Gao Q, Yang XC. A meta-analysis on the efficacy of tai chi in patients with Parkinson’s disease between 2008 and 2014. Evid Based Complement Alternat Med 2015;2015:593263. Epub 2015 Jan 8.

40. Šumec R, Filip P, Sheardová K, Bareš M. Psychological benefits of nonphar- macological methods aimed for improving balance in Parkinson’s disease: a systematic review. Behav Neurol 2015;2015:620674.

41. Yang Y, Qiu WQ, Hao YL, Lv ZY, Jiao SJ, Teng JF. The efficacy of traditional Chinese medical exercise for Parkinson’s disease: a systematic review and meta-analysis. PLoS One 2015;10(4):e0122469.

42. Bega D, Gonzalez-Latapi P, Zadikoff C, Simuni T. A review of the clinical evidence for complementary and alternative therapies in Parkinson’s disease.

Curr Treat Options Neurol 2014;16(10):1-19.

43. Yang Y, Li X, Gong L, Zhu Y, Hao Y. Tai chi for improvement of motor func- tion, balance and gait in Parkinson’s disease: a systematic review and meta- analysis. PLoS One 2014;9(7):e102942.

44. Ni X, Liu S, Lu F, Shi X, Guo X. Efficacy and safety of tai chi for Parkinson’s disease: a systematic review and meta-analysis of randomized controlled tri- als. PLoS One 2014;9(6):e99377. Epub 2014 Jun 13.

45. Toh SF. A systematic review on the effectiveness of tai chi exercise in indi- viduals with Parkinson’s disease from 2003 to 2013. Hong Kong Occup Ther 2013;23(2):69-81.

46. Lee MS, Lam P, Ernst E. Effectiveness of tai chi for Parkinson’s disease: a crit- ical review. Parkinsonism Relat Disord 2008;14(8):589-94. Epub 2008 Apr 18.

47. Li F, Harmer P, Fitzgerald K, Eckstrom E, Stock R, Galver J, et al. Tai chi and postural stability in patients with Parkinson’s disease. N Engl J Med 2012;366(6):511-9.

48. Zhang TY, Hu Y, Nie ZY, Jin RX, Chen F, Guan Q, et al. Effects of tai chi and multimodal exercise training on movement and balance function in mild to moderate idiopathic Parkinson disease. Am J Phys Med Rehabil 2015;94(10 Suppl 1):921-9. Erratum in: Am J Phys Med Rehabil 2015;94(12):e129.

49. Gao Q, Leung A, Yang Y, Wei Q, Guan M, Jia C, et al. Effects of tai chi on balance and fall prevention in Parkinson’s disease: a randomized controlled trial. Clin Rehabil 2014;28(8):748-53. Epub 2014 Feb 11.

50. Ghaffari BD, Kluger B. Mechanisms for alternative treatments in Parkinson’s disease: acupuncture, tai chi, and other treatments. Curr Neurol Neurosci Rep 2014;14(6):1-11.

51. Li F, Harmer P, Liu Y, Eckstrom E, Fitzgerald K, Stock R, et al. A random- ized controlled trial of patient-reported outcomes with tai chi exercise in Parkinson’s disease. Mov Disord 2014;29(4):539-45. Epub 2013 Dec 29.

52. Li F, Harmer P. Economic evaluation of a Tai Ji Quan intervention to reduce falls in people with Parkinson disease, Oregon, 2008-2011. Prev Chronic Dis 2015;12:E120.

53. Yang Y, Hao YL, Tian WJ, Gong L, Zhang K, Shi QG, et al. The effectiveness of tai chi for patients with Parkinson’s disease: study protocol for a random- ized controlled trial. Trials 2015;16:111.

54. Guo JB, Chen BL, Lu YM, Zhang WY, Zhu ZJ, Yang YJ, et al. Tai chi for improv- ing cardiopulmonary function and quality of life in patients with chronic obstructive pulmonary disease: a systematic review and meta-analysis.

Clin Rehabil 2016;30(8):750-64. Epub 2015 Sep 22.

55. Ng BH, Tsang HW, Ng BF, So CT. Traditional Chinese exercises for pulmo- nary rehabilitation: evidence from a systematic review. J Cardiopulm Rehabil Prev 2014;34(6):367-77.

56. Andrianopoulos V, Klijn P, Franssen FM, Spruit MA. Exercise training in pul- monary rehabilitation. Clin Chest Med 2014;35(2):313-22.

57. Wu W, Liu X, Wang L, Wang Z, Hu J, Yan J. Effects of tai chi on exercise capacity and health-related quality of life in patients with chronic obstruc- tive pulmonary disease: a systematic review and meta-analysis. Int J Chron Obstruct Pulmon Dis 2014;9:1253-63.

58. Ding M, Zhang W, Li K, Chen X. Effectiveness of t’ai chi and qigong on chronic obstructive pulmonary disease: a systematic review and meta-analysis.

J Altern Complement Med 2014;20(2):79-86. Epub 2013 Aug 20.

59. Yan J, Guo Y, Yao H, Pan L. Effects of tai chi in patients with chronic obstructive pulmonary disease: preliminary evidence. PLoS One 2013;8(4):e61806.

60. Moy ML, Wayne PM, Litrownik D, Beach D, Klings ES, Davis RB, et al. Long- term Exercise after Pulmonary Rehabilitation (LEAP): design and rationale of a randomized controlled trial of tai chi. Contemp Clin Trials 2015;45(Pt B):458- 67. Epub 2015 Sep 8.

61. Yeh GY, Wayne PM, Litrownik D, Roberts DH, Davis RB, Moy ML. Tai chi mind-body exercise in patients with COPD: study protocol for a randomized controlled trial. Trials 2014;15:337.

62. Lehert P, Villaseca P, Hogervorst E, Maki P, Henderson V. Individually modifi- able risk factors to ameliorate cognitive aging: a systematic review and meta- analysis. Climacteric 2015;18(5):678-89. Epub 2015 Sep 11.

63. Zheng G, Liu F, Li S, Huang M, Tao J, Chen L. Tai chi and the protection of cognitive ability: a systematic review of prospective studies in healthy adults.

Am J Prev Med 2015;49(1):89-97.

64. Kelly ME, Loughrey D, Lawlor BA, Robertson IH, Walsh C, Brennan S. The impact of exercise on the cognitive functioning of healthy older adults: a system- atic review and meta-analysis. Ageing Res Rev 2014;16:12-31. Epub 2014 May 23.

65. Wayne PM, Walsh JN, Taylor‐Piliae RE, Wells RE, Papp KV, Donovan NJ, et al.

Effect of tai chi on cognitive performance in older adults: systematic review and meta‐analysis. J Am Geriatr Soc 2014;62(1):25-39. Epub 2014 Jan 2.

66. Miller SM, Taylor-Piliae RE. Effects of tai chi on cognitive function in community- dwelling older adults: a review. Geriatr Nurs 2014;35(1):9-19. Epub 2013 Oct 24.

67. Walsh JN, Manor B, Hausdorff J, Novak V, Lipsitz L, Gow B, et al. Impact of short- and long-term tai chi mind-body exercise training on cognitive func- tion in healthy adults: results from a hybrid observational study and random- ized trial. Glob Adv Health Med 2015;4(4):38-48.

68. Sun J, Kanagawa K, Sasaki J, Ooki S, Xu H, Wang L. Tai chi improves cogni- tive and physical function in the elderly: a randomized controlled trial. J Phys Ther Sci 2015;27(5):1467-71. Epub 2015 May 26.

69. Wang F, Lee EO, Wu T, Benson H, Fricchione G, Wang W, et al. The effects of tai chi on depression, anxiety, and psychological well-being: a systematic review and meta-analysis. Int J Behav Med 2014;21(4):605-17.

70. Rosenbaum S, Tiedemann A, Sherrington C, Curtis J, Ward PB. Physical activity interventions for people with mental illness: a systematic review and meta-analysis. J Clin Psychiatry 2014;75(9):964-74.

71. Chi I, Jordan‐Marsh M, Guo M, Xie B, Bai Z. Tai chi and reduction of depres- sive symptoms for older adults: a meta‐analysis of randomized trials. Geriatr Gerontol Int 2013;13(1):3-12. Epub 2012 Jun 10.

72. Woltz PC, Chapa DW, Friedmann E, Son H, Akintade B, Thomas SA. Effects of interventions on depression in heart failure: a systematic review. Heart Lung 2012;41(5):469-83.

73. Bridle C, Spanjers K, Patel S, Atherton NM, Lamb SE. Effect of exercise on depression severity in older people: systematic review and meta-analysis of randomised controlled trials. Br J Psychiatry 2012;201(3):180-5.

74. Yohannes AM, Caton S. Management of depression in older people with osteoarthritis: a systematic review. Aging Ment Health 2010;14(6):637-51.

75. Tsang HW, Chan EP, Cheung W. Effects of mindful and non‐mindful exer- cises on people with depression: a systematic review. Br J Clin Psychol 2008;47(Pt 3):303-22. Epub 2008 Jan 31.

76. Liu X, Clark J, Siskind D, Williams GM, Byrne G, Yang JL, et al. A systematic review and meta-analysis of the effects of qigong and tai chi for depressive symptoms. Complement Ther Med 2015;23(4):516-34. Epub 2015 May 27.

77. Liu X, Vitetta L, Kostner K, Crompton D, Williams G, Brown WJ, et al. The effects of tai chi in centrally obese adults with depression symptoms. Evid Based Complement Alternat Med 2015;2015:879712. Epub 2015 Jan 21.

78. Nery RM, Zanini M, Ferrari JN, Silva CA, Farias LF, Comel JC, et al. Tai chi chuan for cardiac rehabilitation in patients with coronary arterial disease. Arq Bras Cardiol 2014;102(6):588-92. Epub 2014 Apr 17.

79. Yeh GY, Wang C, Wayne PM, Phillips R. Tai chi exercise for patients with cardiovascular conditions and risk factors: a systematic review. J Cardiopulm Rehabil Prev 2009;29(3):152-60.

80. Lee MS, Pittler MH, Taylor-Piliae RE, Ernst E. Tai chi for cardiovascular dis- ease and its risk factors: a systematic review. J Hypertens 2007;25(9):1974-5.

81. Dalusung‐Angosta A. The impact of tai chi exercise on coronary heart disease:

a systematic review. J Am Acad Nurse Pract 2011;23(7):376-81. Epub 2011 Mar 31.

82. Lan C, Chen S, Wong M, Lai JS. Tai chi chuan exercise for patients with car- diovascular disease. Evid Based Complement Alternat Med 2013;2013:983208.

83. Ng S, Wang C, Ho R, Ziea T, Wong V, Chan CL. Tai chi exercise for patients with heart disease: a systematic review of controlled clinical trials. Altern Ther Health Med 2012;18(3):16-22. Erratum in: Altern Ther Health Med 2012;18(6):79.

84. Robins JL, Elswick R Jr, Sturgill J, McCain NL. The effects of tai chi on cardio- vascular risk in women. Am J Health Promot 2015 Aug 25. Epub ahead of print.

85. Xu F, Letendre J, Bekke J, Beebe N, Mahler L, Lofgren IE, et al. Impact of a program of tai chi plus behaviorally based dietary weight loss on physi- cal functioning and coronary heart disease risk factors: a community-based study in obese older women. J Nutr Gerontol Geriatr 2015;34(1):50-65.

86. Song Q, Xu R, Shen G, Zhang Q, Ma M, Zhao X, et al. Influence of tai chi exercise cycle on the senile respiratory and cardiovascular circulatory func- tion. Int J Clin Exp Med 2014;7(3):770-4.

87. Nery RM, Zanini M, de Lima JB, Bühler RP, da Silveira AD, Stein R. Tai chi chuan improves functional capacity after myocardial infarction: a random- ized clinical trial. Am Heart J 2015;169(6):854-60. Epub 2015 Mar 13.

88. Salmoirago-Blotcher E, Wayne P, Bock BC, Dunsiger S, Wu W, Stabile L, et al. Design and methods of the Gentle Cardiac Rehabilitation Study—a behav- ioral study of tai chi exercise for patients not attending cardiac rehabilitation.

Contemp Clin Trials 2015;43:243-51. Epub 2015 Jun 24.

89. Ding M. Tai chi for stroke rehabilitation: a focused review. Am J Phys Med Rehabil 2012;91(12):1091-6.

90. Taylor-Piliae RE, Haskell WL. Tai chi exercise and stroke rehabilitation. Top Stroke Rehabil 2007;14(4):9-22.

91. Rabadi MH. Review of the randomized clinical stroke rehabilitation trials in 2009. Med Sci Monit 2011;17(2):RA25-43.

92. Chen B, Guo J, Liu M, Li X, Zou J, Chen X, et al. Effect of traditional Chinese exercise on gait and balance for stroke: a systematic review and meta-analysis.

PLoS One 2015;10(8):e0135932.

93. Kim H, Kim YL, Lee SM. Effects of therapeutic tai chi on balance, gait, and quality of life in chronic stroke patients. Int J Rehabil Res 2015;38(2):156-61.

94. Taylor-Piliae RE, Hoke TM, Hepworth JT, Latt LD, Najafi B, Coull BM. Effect of tai chi on physical function, fall rates and quality of life among older stroke survivors. Arch Phys Med Rehabil 2014;95(5):816-24. Epub 2014 Jan 17.

95. Tao J, Rao T, Lin L, Liu W, Wu Z, Zheng G, et al. Evaluation of tai chi yun- shou exercises on community-based stroke patients with balance dys- function: a study protocol of a cluster randomized controlled trial. BMC Complement Altern Med 2015;15(1):31.

96. Taylor-Piliae RE, Coull BM. Community-based Yang-style tai chi is safe and feasible in chronic stroke: a pilot study. Clin Rehabil 2012;26(2):121-31. Epub 2011 Sep 21.

97. Zhang Y, Liu H, Zhou L, Chen K, Jin H, Zou Y, et al. Applying tai chi as a rehabilitation program for stroke patients in the recovery phase: study proto- col for a randomized controlled trial. Trials 2014;15:484.

98. Forbes D, Thiessen EJ, Blake CM, Forbes SC, Forbes S. Exercise programs for people with dementia. Cochrane Database Syst Rev 2013;(12):CD006489.

99. Fogarty JN, Murphy KJ, McFarlane B, Montero-Odasso M, Wells J, Troyer AK, et al. Taoist Tai Chi^® and memory intervention for individuals with mild cog- nitive impairment. J Aging Phys Act 2016;24(2):169-80. Epub 2015 Apr 2.

100. Zeng Y, Luo T, Xie H, Huang M, Cheng AS. Health benefits of qigong or tai chi for cancer patients: a systematic review and meta-analyses. Complement Ther Med 2014;22(1):173-86. Epub 2013 Dec 18.

101. Yan JH, Pan L, Zhang XM, Sun CX, Cui GH. Lack of efficacy of tai chi in improving quality of life in breast cancer survivors: a systematic review and meta-analysis. Asian Pac J Cancer Prev 2014;15(8):3715-20.

102. Mishra SI, Scherer RW, Geigle PM, Berlanstein DR, Topaloglu O, Gotay CC, et al. Exercise interventions on health-related quality of life for cancer survi- vors. Cochrane Database Syst Rev 2012;(8):CD007566.

103. Brown JC, Huedo-Medina TB, Pescatello LS, Pescatello SM, Ferrer RA, Johnson BT. Efficacy of exercise interventions in modulating cancer-related fatigue among adult cancer survivors: a meta-analysis. Cancer Epidemiol Biomarkers Prev 2011;20(1):123-33. Epub 2010 Nov 4.

104. Lee MS, Choi TY, Ernst E. Tai chi for breast cancer patients: a systematic review. Breast Cancer Res Treat 2010;120(2):309-16. Epub 2010 Feb 2.

105. Lee MS, Pittler MH, Ernst E. Is tai chi an effective adjunct in cancer care? A systematic review of controlled clinical trials. Support Care Cancer 2007;15(6):597-601. Epub 2007 Feb 21.

106. Mishra SI, Scherer RW, Geigle PM, Berlanstein DR, Topaloglu O, Gotay CC, et al. Exercise interventions on health-related quality of life for peo- ple with cancer during active treatment. Cochrane Database Syst Rev 2012;(8):CD008465.

107. Sprod LK, Janelsins MC, Palesh OG, Carroll JK, Heckler CE, Peppone LJ, et al.

Health-related quality of life and biomarkers in breast cancer survivors partici- pating in tai chi chuan. J Cancer Surviv 2012;6(2):146-54. Epub 2011 Dec 10.

108. Lauche R, Cramer H, Häuser W, Dobos G, Langhorst J. A systematic over- view of reviews for complementary and alternative therapies in the treat- ment of the fibromyalgia syndrome. Evid Based Complement Alternat Med 2015;2015:610615.

109. Bidonde J, Busch AJ, Bath B, Milosavljevic S. Exercise for adults with fibro- myalgia: an umbrella systematic review with synthesis of best evidence. Curr Rheumatol Rev 2014;10(1):45-79.

110. Mist SD, Firestone KA, Jones KD. Complementary and alternative exercise for fibromyalgia: a meta-analysis. J Pain Res 2013;6:247-60. Epub 2013 Mar 27.

111. Langhorst J, Klose P, Dobos GJ, Bernardy K, Häuser W. Efficacy and safety of meditative movement therapies in fibromyalgia syndrome: a systematic review and meta-analysis of randomized controlled trials. Rheumatol Int 2013;33(1):193-207. Epub 2012 Feb 15.

112. Wang C, Schmid CH, Rones R, Kalish R, Yinh J, Goldenberg DL, et al. A randomized trial of tai chi for fibromyalgia. N Engl J Med 2010;363(8):743-54.

113. Segura-Jiménez V, Romero-Zurita A, Carbonell-Baeza A, Aparicio V, Ruiz JR, Delgado-Fernández M. Effectiveness of tai-chi for decreasing acute pain in fibromyalgia patients. Int J Sports Med 2014;35(05):418-23.

Epub 2013 Nov 7.

114. Jones KD, Sherman CA, Mist SD, Carson JW, Bennett RM, Li F. A ran- domized controlled trial of 8-form tai chi improves symptoms and func- tional mobility in fibromyalgia patients. Clin Rheumatol 2012;31(8):1205-14.

Epub 2012 May 13.

115. Wang C, McAlindon T, Fielding RA, Harvey WF, Driban JB, Price LL, et al. A novel comparative effectiveness study of tai chi versus aerobic exercise for fibromyalgia: study protocol for a randomized controlled trial. Trials 2015;16:34.

116. Ablin J, Fitzcharles M, Buskila D, Shir Y, Sommer C, Häuser W. Treatment of fibromyalgia syndrome: recommendations of recent evidence-based interdisciplinary guidelines with special emphasis on complemen- tary and alternative therapies. Evid Based Complement Alternat Med 2013;2015:485272.

117. Wang J, Feng B, Yang X, Liu W, Teng F, Li S, et al. Tai chi for essential hyperten- sion. Evid Based Complement Alternat Med 2013;2013:215254. Epub 2013 Aug 6.

118. Lee MS, Lee EN, Kim JI, Ernst E. Tai chi for lowering resting blood pressure in the elderly: a systematic review. J Eval Clin Pract 2010;16(4):818-24. Epub 2010 Jun 14.

119. Lee MS, Pittler MH, Taylor-Piliae RE, Ernst E. Tai chi for cardiovascular dis- ease and its risk factors. J Hypertension 2007;25(9):1974-7.

120. Yeh GY, Wang C, Wayne PM, Phillips RS. The effect of tai chi exercise on blood pressure: a systematic review. Prev Cardiol 2008;11(2):82-9.

121. Sun J, Buys N. Community-based mind-body meditative tai chi program and its effects on improvement of blood pressure, weight, renal function, serum lipoprotein, and quality of life in Chinese adults with hypertension. Am J Cardiol 2015;116(7):1076-81. Epub 2015 Jul 16.

122. Wayne PM, Kiel DP, Krebs DE, Davis RB, Savetsky-German J, Connelly M, et al. The effects of tai chi on bone mineral density in postmenopausal women: a systematic review. Arch Phys Med Rehabil 2007;88(5):673-80.

123. Lee M, Pittler M, Shin B, Ernst E. Tai chi for osteoporosis: a systematic review. Osteoporos Int 2008;19(2):139-46. Epub 2007 Oct 23.

124. Chang TJ, Ting YT, Sheu SL, Chang HY. Effects of tai chi in postmenopausal women with osteoporosis: a systematic review [article in Chinese]. Hu Li Za Zhi 2014;61(5):75-84.

125. Wang H, Yu B, Chen W, Lu Y, Yu D. Simplified tai chi resistance training versus traditional tai chi in slowing bone loss in postmenopausal women.

Evid Based Complement Alternat Med 2015;2015:379451.

126. Wayne PM, Kiel DP, Buring JE, Connors EM, Bonato P, Yeh GY, et al.

Impact of tai chi exercise on multiple fracture-related risk factors in post- menopausal osteopenic women: a pilot pragmatic, randomized trial. BMC Complement Altern Med 2012;12:7.

127. Zheng G, Huang M, Liu F, Li S, Tao J, Chen L. Tai chi chuan for the primary prevention of stroke in middle-aged and elderly adults: a systematic review.

Evid Based Complement Alternat Med 2015;2015:742152.

128. Hartley L, Flowers N, Lee MS, Ernst E, Rees K. Tai chi for primary preven- tion of cardiovascular disease. Cochrane Database Syst Rev 2014;(4):CD010366.

129. Sharma M, Haider T. Tai chi as an alternative and complimentary ther- apy for anxiety: a systematic review. Evid Based Complement Alternat Med 2015;20(2):143-53. Epub 2014 Dec 8.

130. Yuan QL, Guo TM, Liu L, Sun F, Zhang YG. Traditional Chinese medicine for neck pain and low back pain: a systematic review and meta-analysis.

PLoS One 2015;10(2):e0117146.

131. Lu T, Song QH, Xu RM, Zhang LY. Effect of tai chi exercise in combination with auricular plaster on patients with lumbar muscle strain. Int J Clin Exp Med 2015;8(2):2949-53.

132. Hall AM, Maher CG, Lam P, Ferreira M, Latimer J. Tai chi exercise for treat- ment of pain and disability in people with persistent low back pain: a ran- domized controlled trial. Arthritis Care Res 2011;63(11):1576-83.

133. Cho Y. Effects of tai chi on pain and muscle activity in young males with acute low back pain. J Phys Ther Sci 2014;26(5):679-81. Epub 2014 May 29.

134. Pan Y, Yang K, Shi X, Liang H, Zhang F, Lv Q. Tai chi chuan exercise for patients with breast cancer: a systematic review and meta-analysis. Evid Based Complement Alternat Med 2015;2015:535237.

135. Azimzadeh E, Hosseini MA, Nourozi K, Davidson PM. Effect of tai chi chuan on balance in women with multiple sclerosis. Complement Ther Clin Pract 2015;21(1):57-60. Epub 2014 Nov 27.

136. Burschka JM, Keune PM, Oy UH, Oschmann P, Kuhn P. Mindfulness-based interventions in multiple sclerosis: beneficial effects of tai chi on balance, coordination, fatigue and depression. BMC Neurol 2014;14(1):165.

137. Mills N, Allen J, Carey-Morgan S. Does tai chi/qi gong help patients with multiple sclerosis? J Bodyw Mov Ther 2000;4(1):39-48.

138. Husted C, Pham L, Hekking A, Niederman R. Improving quality of life for people with chronic conditions: the example of t’ai chi and multiple sclerosis.

Altern Ther Health Med 1999;5(5):70-4.

139. Vera-Garcia E, Mayoral-Cleries F, Vancampfort D, Stubbs B, Cuesta-Vargas AI. A systematic review of the benefits of physical therapy within a multidisciplinary care approach for people with schizophrenia: an update. Psychiatry Res 2015;229(3):828- 39. Epub 2015 Jul 31.

140. Ho RT, Wan AH, Au-Yeung FS, Lo PH, Siu PJ, Wong CP, et al. The psy- chophysiological effects of tai-chi and exercise in residential schizophrenic patients: a 3-arm randomized controlled trial. BMC Complement Altern Med 2014;14:364.

141. Kim SH, Schneider SM, Kravitz L, Mermier C, Burge MR. Mind-body prac- tices for posttraumatic stress disorder. J Investig Med 2013;61(5):827-34.

142. Grodin MA, Piwowarczyk L, Fulker D, Bazazi AR, Saper RB. Treating sur- vivors of torture and refugee trauma: a preliminary case series using qigong and t’ai chi. J Altern Complement Med 2008;14(7):801-6.

143. Converse AK, Ahlers EO, Travers BG, Davidson RJ. Tai chi training reduces self-report of inattention in healthy young adults. Front Hum Neurosci 2014;8:13.

144. Ni X, Zhang-James Y, Han X, Lei S, Sun J, Zhou R. Traditional Chinese medicine in the treatment of ADHD: a review. Child Adolesc Psychiatr Clin N Am 2014;23(4):853-81.

145. Catalá-López F, Hutton B, Núñez-Beltran A, Mayhew AD, Page MJ, Ridao M, et al. The pharmacological and non-pharmacological treatment of atten- tion deficit hyperactivity disorder in children and adolescents: protocol for a systematic review and network meta-analysis of randomized controlled trials.

Syst Rev 2015;4:19. Epub 2015 Feb 27.

146. Tsang WW, Gao KL, Chan K, Purves S, Macfarlane DJ, Fong SS. Sitting tai chi improves the balance control and muscle strength of community-dwelling persons with spinal cord injuries: a pilot study. Evid Based Complement Alternat Med 2015;2015:523852.

147. Gemmell C, Leathem JM. A study investigating the effects of tai chi chuan:

individuals with traumatic brain injury compared to controls. Brain Inj 2006;20(2):151-6.

148. Fong SS, Ng SS, Lee HW, Pang MY, Luk WS, Chung JW, et al. The effects of a 6-month tai chi qigong training program on temporomandibular, cervi- cal, and shoulder joint mobility and sleep problems in nasopharyngeal cancer survivors. Integr Cancer Ther 2015;14(1):16-25. Epub 2014 Nov 18.

149. Lee MS, Jun JH, Lim HJ, Lim HS. A systematic review and meta-analysis of tai chi for treating type 2 diabetes. Maturitas 2015;80(1):14-23. Epub 2014 Sep 29.

150. Van der Heijden MM, van Dooren FE, Pop VJ, Pouwer F. Effects of exer- cise training on quality of life, symptoms of depression, symptoms of anxiety and emotional well-being in type 2 diabetes mellitus: a systematic review.

Diabetologia 2013;56(6):1210-25. Epub 2013 Mar 23.

151. Yan JH, Gu WJ, Pan L. Lack of evidence on tai chi-related effects in patients with type 2 diabetes mellitus: a meta-analysis. Exp Clin Endocrinol Diabetes 2013;121(5):266-71. Epub 2013 Feb 28.

152. Lee MS, Choi TY, Lim HJ, Ernst E. Tai chi for management of type 2 diabe- tes mellitus: a systematic review. Chin J Integr Med 2011;17(10):789-93. Epub 2011 Jul 30.

153. Liu X, Miller YD, Burton NW, Chang JH, Brown WJ. The effect of tai chi on health-related quality of life in people with elevated blood glucose or diabetes: a randomized controlled trial. Qual Life Res 2013;22(7):1783-6. Epub 2012 Nov 10.

154. Han A, Judd M, Welch V, Wu T, Tugwell P, Wells G. Tai chi for rheumatoid arthritis. Cochrane Database Syst Rev 2004;(3):CD004849.

155. Macfarlane GJ, Paudyal P, Doherty M, Ernst E, Lewith G, MacPherson H, et al. A systematic review of evidence for the effectiveness of practitioner-based complementary and alternative therapies in the management of rheumatic diseases: rheumatoid arthritis. Rheumatology (Oxford) 2012;51(9):1707-13.

Epub 2012 Aug 25.

156. Lee MS, Pittler MH, Ernst E. Tai chi for rheumatoid arthritis: systematic review. Rheumatology (Oxford) 2007;46(11):1648-51. Epub 2007 Jul 18.

157. Waite‐Jones JM, Hale CA, Lee HY. Psychosocial effects of tai chi exercise on people with rheumatoid arthritis. J Clin Nurs 2013;22(21-22):3053-61. Epub 2013 Sep 13.

158. Pan L, Yan J, Guo Y, Yan J. Effects of tai chi training on exercise capacity and quality of life in patients with chronic heart failure: a meta‐analysis.

Eur J Heart Fail 2013;15(3):316-23. Epub 2012 Oct 25.

159. Chen YW, Hunt MA, Campbell KL, Peill K, Reid WD. The effect of tai chi on four chronic conditions—cancer, osteoarthritis, heart failure and chronic obstructive pulmonary disease: a systematic review and meta-analyses.

Br J Sports Med 2016;50(7):397-407. Epub 2015 Sep 17.

160. Sun J, Buys N, Jayasinghe R. Effects of community-based meditative tai chi programme on improving quality of life, physical and mental health in chronic heart-failure participants. Aging Ment Health 2014;18(3):289-95. Epub 2014 Jan 9.

161. Chan WW, Bartlett DJ. Effectiveness of tai chi as a therapeutic exer- cise in improving balance and postural control. Phys Occup Ther Geriatr 2000;17(3):1-22.

162. Song R, Ahn S, So H, Lee EH, Chung Y, Park M. Effects of t’ai chi on balance: a population-based meta-analysis. J Altern Complement Med 2015;21(3):141-51. Epub 2015 Feb 4.

163. Huang Y, Liu X. Improvement of balance control ability and flexibility in the elderly tai chi chuan (TCC) practitioners: a systematic review and meta- analysis. Arch Gerontol Geriatr 2015;60(2):233-8. Epub 2014 Nov 18.

164. Leung DP, Chan CK, Tsang HW, Tsang WW, Jones AY. Tai chi as an inter- vention to improve balance and reduce falls in older adults: a systematic and meta-analytical review. Altern Ther Health Med 2011;17(1):40-8.

165. Wooton AC. An integrative review of tai chi research: an alternative form of physical activity to improve balance and prevent falls in older adults.

Orthop Nurs 2010;29(2):108-16.

166. Howe TE, Rochester L, Neil F, Skelton DA, Ballinger C. Exercise for improv- ing balance in older people. Cochrane Database Syst Rev 2011;(11):CD004963.

167. Komagata S, Newton R. The effectiveness of tai chi on improving balance in older adults: an evidence-based review. J Geriatr Phys Ther 2003;26(2):9-16.

168. Liu H, Frank A. Tai chi as a balance improvement exercise for older adults:

a systematic review. J Geriatr Phys Ther 2010;33(3):103-9.

169. Maciaszek J, Osiński W. The effects of tai chi on body balance in elderly people—a review of studies from the early 21st century. Am J Chin Med 2010;38(2):219-29.

170. Wu G. Evaluation of the effectiveness of tai chi for improving balance and preventing falls in the older population—a review. J Am Geriatr Soc 2002;50(4):746-54.

171. Alsubiheen A, Petrofsky J, Daher N, Lohman E, Balbas E. Effect of tai chi exercise combined with mental imagery theory in improving balance in a dia- betic and elderly population. Med Sci Monit 2015;21:3054-61.

172. Zeng R, Lin J, Wu S, Chen L, Chen S, Gao H, et al. A randomized controlled trial: preoperative home-based combined tai chi and strength training (TCST) to improve balance and aerobic capacity in patients with total hip arthro- plasty (THA). Arch Gerontol Geriatr 2015;60(2):265-71. Epub 2014 Dec 13.

173. Zheng G, Lan X, Li M, Ling K, Lin H, Chen L, et al. Effectiveness of tai chi on physical and psychological health of college students: results of a ran- domized controlled trial. PLoS One 2015;10(7):e0132605.

174. Escalante Y, García-Hermoso A, Saavedra JM. Effects of exercise on func- tional aerobic capacity in lower limb osteoarthritis: a systematic review. J Sci Med Sport 2011;14(3):190-8. Epub 2010 Nov 25.

175. Lee MS, Lee EN, Ernst E. Is tai chi beneficial for improving aerobic capacity?

A systematic review. Br J Sports Med 2009;43(8):569-73. Epub 2008 Nov 19.

176. Taylor-Piliae RE. The effectiveness of tai chi exercise in improving aerobic capacity: an updated meta-analysis. Med Sport Sci 2008;52:40-53.

177. Taylor-Piliae RE, Froelicher ES. Effectiveness of tai chi exercise in improv- ing aerobic capacity: a meta-analysis. J Cardiovasc Nurs 2004;19(1):48-57.

178. Kim TH, Eke Dogra S, Al-Sahab B, Tamim H. Comparison of functional fit- ness outcomes in experienced and inexperienced older adults after 16-week tai chi program. Altern Ther Health Med 2014;20(3):20-5.

179. Liu B, Liu ZH, Zhu HE, Mo JC, Cheng DH. Effects of tai chi on lower- limb myodynamia in the elderly people: a meta-analysis. J Tradit Chin Med 2011;31(2):141-6.

180. Zhou M, Peng N, Dai Q, Li HW, Shi RG, Huang W. Effect of tai chi on mus- cle strength of the lower extremities in the elderly. Chin J Integr Med 2015 May 27. Epub ahead of print.

181. Lin SF, Sung HC, Li TL, Hsieh TC, Lan HC, Perng SJ, et al. The effects of tai‐chi in conjunction with thera‐band resistance exercise on functional fit- ness and muscle strength among community‐based older people. J Clin Nurs 2015;24(9-10):1357-66. Epub 2015 Jan 26.

182. Manson J, Rotondi M, Jamnik V, Ardern C, Tamim H. Effect of tai chi on mus- culoskeletal health-related fitness and self-reported physical health changes in low income, multiple ethnicity mid to older adults. BMC Geriatr 2013;13:114.

183. Wang C, Bannuru R, Ramel J, Kupelnick B, Scott T, Schmid CH. Tai chi on psychological well-being: systematic review and meta-analysis. BMC Complement Altern Med 2010;10:23.

184. Wang WC, Zhang AL, Rasmussen B, Lin LW, Dunning T, Kang SW, et al.

The effect of tai chi on psychosocial well-being: a systematic review of ran- domized controlled trials. J Acupunct Meridian Stud 2009;2(3):171-81.

185. Dechamps A, Lafont L, Bourdel-Marchasson I. Effects of tai chi exercises on self-efficacy and psychological health. Eur Rev Aging Phys Act 2007;4(1):25-32.

186. Du S, Dong J, Zhang H, Jin S, Xu G, Liu Z, et al. Taichi exercise for self- rated sleep quality in older people: a systematic review and meta-analysis. Int J Nurs Stud 2015;52(1):368-79. Epub 2014 May 28.

187. Sarris J, Byrne GJ. A systematic review of insomnia and complementary medicine. Sleep Med Rev 2011;15(2):99-106. Epub 2010 Jun 8.

188. Irwin MR, Olmstead R, Breen EC, Witarama T, Carrillo C, Sadeghi N, et al.

Cognitive behavioral therapy and tai chi reverse cellular and genomic mark- ers of inflammation in late life insomnia: a randomized controlled trial. Biol Psychiatry 2015;78(10):721-9. Epub 2015 Feb 4.

189. Irwin MR, Olmstead R, Breen EC, Witarama T, Carrillo C, Sadeghi N, et al. Tai chi, cellular inflammation, and transcriptome dynamics in breast can- cer survivors with insomnia: a randomized controlled trial. J Natl Cancer Inst Monogr 2014;2014(50):295-301.

190. Irwin MR, Olmstead R, Carrillo C, Sadeghi N, Breen EC, Witarama T, et al. Cognitive behavioral therapy vs. tai chi for late life insomnia and inflam- matory risk: a randomized controlled comparative efficacy trial. Sleep 2014;37(9):1543-52.

191. Carroll JE, Seeman TE, Olmstead R, Melendez G, Sadakane R, Bootzin R, et al. Improved sleep quality in older adults with insomnia reduces biomarkers of disease risk: pilot results from a randomized controlled comparative effi- cacy trial. Psychoneuroendocrinology 2015;55:184-92. Epub 2015 Feb 25.